SummarySpontaneous rupture of utero-ovarian vessels in pregnancy is rare and usually involves utero-ovarian veins. Presenting symptoms include acute-onset abdominal pain and maternal hypovolemic shock secondary to haemoperitoneum. Although this condition had been documented over a century ago, an accurate diagnosis is rarely reached prior to laparotomy due to a multitude of other surgical and obstetrical presentations that may pose a similar clinical picture. In such an event an emergency exploratory laparotomy followed by caesarean section with ligation of the uterine vessels can help in preventing a maternal mortality. BACKGROUND

Our objective was to evaluate the effect of a change in treatment protocols, suggested following an inspection visit by the regulatory authority, from single to double inseminations during donor insemination treatment cycles. We therefore conducted a retrospective audit of pregnancy rates in the reproductive medicine clinic of a major teaching hospital. All patients were treated for male factor infertility by donor insemination, without ovulation induction with gonadotrophins between October 1992 and December 1995. The main outcome measures were cumulative conception and live birth rates. During the study period 250 patients underwent treatment and 650 single insemination and 277 double insemination treatment cycles were undertaken. The pregnancy rate per cycle was 0.054 and 0.119 for single and double insemination respectively. After six cycles the cumulative pregnancy rates were 0.28 and 0.47 and the take-home baby rates were 0.25 and 0.37 for single and double inseminations respectively. The change in practice from single to double insemination resulted in a doubling of the pregnancy rate per treatment cycle. Cumulative pregnancy rates after two treatment cycles of double insemination were comparable with those achieved after six cycles of single insemination. These results have significant implications for both patients and purchasers.

The object of the study was to investigate the effect on gonadotrophin secretion of a small increase in oestradiol concentration. A total of 13 fully breast-feeding women (12 weeks post-partum) underwent serial blood sampling at 10 min intervals for 12 h on 2 different days; day 1 untreated and day 5 after 3 days of treatment with transcutaneous oestradiol (100 micrograms/day). On both days bolus gonadotrophin-releasing hormone (GnRH; 10 micrograms i.v.) was given after a 10 h baseline period. In six of the subjects, a naloxone infusion was administered during the second study day. Application of transdermal oestradiol raised the oestradiol concentration within the normal follicular phase range. The mean luteinizing hormone (LH) concentration on day 5 was found to be significantly lower than that on day 1 (P < 0.05). The LH response to GnRH was, however, significantly higher on day 5 than day 1 (P < 0.001). The mean follicle stimulating hormone (FSH) concentration on day 5 was also significantly lower than that on day 1 (P < 0.01), while the peak concentration after GnRH was unchanged. When the opioid antagonist naloxone was infused after oestradiol treatment, the subjects with low pre-study oestradiol concentrations exhibited no effect on LH concentration, while in the subjects with higher oestradiol concentrations the LH concentration was increased. It was concluded that the administration of small doses of oestradiol caused a significant fall in gonadotrophin concentration in breast-feeding women.(ABSTRACT TRUNCATED AT 250 WORDS)

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